Theories on Drug Abuse: Selected Contemporary Perspectives

Scientists no longer believe that a drug has a simple physiological action, essentially the same in all humans. Experimental, anthropological, and sociological evidence has convinced most observers that drug effects vary greatly, depending on the physiology and psychology of the persons taking them, on their state when they ingest the drug, and on the social situation. We can understand the social context of drug experiences better by showing how the nature of the experience depends on the amount and kind of knowledge available to the person taking the drug. Since distribution is a function of the social organization of the groups in which drugs are used, drug experiences differ with differences in social organization. This paper will focus primarily on the illegal use of drugs for pleasure—and especially the use of LSD and marijuana—but will also discuss the use of medically prescribed drugs by patients, and the involuntary ingestion of drugs by victims of chemical warfare.2

Drug effects vary from person to person and place to place because they almost always have more than one effect. People may conventionally focus on and recognize only one or a few of these effects, ignoring the others as irrelevant. For example, most people think the effect of aspirin is to control pain; some know that it also reduces fever; few think of gastric irritation as a typical effect, although it is. Thus

2Material in this paragraph was taken from "Consciousness, Power and Drug Effects," p. 67. See footnote 1.

users are likely to focus on the "beneficial" effects they seek and to ignore others.1

DRUG EFFECTS, KNOWLEDGE, AND SOCIAL STRUCTURE

When people take drugs, their subsequent experience is likely to be influenced by their ideas and beliefs about the drug (Becker 1967). What they know about the drug influences the way they use it, the way they interpret its manifold effects and respond to them, and the way they deal with the aftereffects. Conversely, what they do not know also affects their experience, making both certain interpretations and action, based on that missing knowledge, impossible. (l use "knowledge" to refer to any ideas or beliefs about a drug that anyone concerned in its use, e.g., illicit drug sellers, physicians, researchers, or lay drug users, believes to have been tested against experience and thus to carry more weight than mere assertions of faith.)3

DOSAGE

Many drug effects are dose related. The drug has one set of effects if you take X amount and quite different if you take 5X. Similarly, the effects vary depending on the means of taking a drug. How much of a drug you take and how you take it depend on what you have learned from sources you consider knowledgeable and trustworthy.3

Most people know, for instance, that the usual dose of aspirin tablets is two and that they should be swallowed. On the other hand, few people have readily available knowledge about the vast majority of drugs prescribed by doctors or about those illicitly obtained, such as LSD. Persons planning to take a drug (for whatever reason) either resort to trial-and-error experimentation or rely on sources they consider reliable (scientists, physicians, or more experienced drug users). These sources can usually tell the prospective user how much to take and how to take it to achieve whatever the desired effect may be (to control blood clotting time, to get high, or whatever).3

With the understanding thus acquired, users take an amount whose effect they can more or less accurately predict. They usually find this prediction confirmed, though the accuracy of conventional knowledge needs to be known. ln this way, their access to knowledge exerts a direct influence on their experience, allowing them to control the physiological input to that experience.3

This analysis supposes that users have complete control over the amount they take. This is not always true, since a user may wish to take more than the physician will prescribe or a pharmacist sell. On

2Material in these paragraphs was taken from "Consciousness, Power and

Drug Effects," p. 67. See footnote 1. 'Material in these paragraphs was taken from "Consciousness, Power and

Drug Effects," pp. 67-68. See footnote 1.

the other hand, doctors ordinarily prescribe and pharmacists sell amounts larger than recommended for one-time use, so that users can take more than they are "supposed to." They can also purchase drugs illicitly or "semilicitly" (e.g., from a friendly neighborhood pharmacist).3

MAlN EFFECTS

Social scientists have shown how the definitions drug users apply to their experience affect that experience. Persons suffering opiate withdrawal will respond as "typical" addicts if they interpret their distress as opiate withdrawal, but not if they blame the pain on some other cause (e.g., recovery from surgery). Marijuana users must learn to interpret its subtle effect as being different from ordinary experience and as pleasurable before they "get high" (Becker 1953). Native Americans and Caucasians interpret peyote experiences differently (Aberle 1966), and LSD trips have been experienced as consciousness expansion, transcendental religious experience, mock psychosis, or being high (Blum and Associates 1964). ln short, users bring to bear, in interpreting their experience, knowledge and definitions derived from participation in particular social groups.4

SlDE EFFECTS

Side effects are not a medically or pharmacologically distinct category of reactions to drugs. Rather, they are effects not desired either by the user or the person administering the drug. Both side effects and main effects are thus socially defined categories. Mental disorientation might be an unwanted side effect to a physician but a desired main effect for an illicit drug user.4

A drug user's knowledge, if adequate, lets him or her identify unwanted side effects and deal with them in a self-satisfactory way. Users concentrating on a desired main effect may not observe an unpleasant side effect or may not connect it with use of the drug. They interpret their experience most adequately if those who prepare them for the drug's main effects likewise teach them the likely side effects and how to deal with them. lllicit drug users typically teach novices the side effects to look out for, give reassurance about their seriousness, and give instructions in how to avoid or overcome them.5

LSD

The peculiar effects that lysergic acid diethylamide (LSD-25) has on the mind were discovered in 1938 by Albert Hoffman, who synthesized the drug in 1943. Following World War ll, it came into use in

'Material in this paragraph was taken from "Consciousness, Power and

Drug Effects," pp. 67-68. See footnote 1. 'Material in these paragraphs was taken from "Consciousness, Power and

Drug Effects," pp. 68-69. See footnote 1.

'Material in this paragraph was taken from "Consciousness, Power and Drug Effects," p. 69. See footnote 1.

psychiatry, both as a method of simulating psychosis for clinical study and as a means of therapy (Unger 1966), and has been the subject of controversy ever since. At one extreme, Timothy Leary considers its use so beneficial that he has founded a new religion in which it is the major sacrament. At the other extreme, psychiatrists, police, and journalists allege that LSD is extremely dangerous, that it produces psychosis, and that persons under its influence are likely to commit acts dangerous to themselves and others that they would not otherwise commit.

ln spite of the great interest in the drug, l think it is fair to say that the evidence of its danger is by no means decisive (Cohen 1960; Cohen and Ditman 1962, 1963; Frosch et al. 1965; Hoffer 1965; Rosenthal 1964; Ungerleider et al. 1966). lf the drug does prove to be the cause of a bona fide psychosis, it will be the only case in which anyone can state with authority that they have found the unique cause of any such phenomenon.

But if we refuse to accept the explanations of others, we are obligated to provide one of our own. ln what follows, l will consider the reports of LSD-induced psychoses and try to relate them to what is known of the social psychology and sociology of drug use. By keeping in mind what is known of the influence that knowledge and social orientation have on the effects—both main effects and side effects—that a drug user experiences, l hope to add both to our understanding of the current controversy over LSD and to our general knowledge of the social character of drug use. ln particular, l will make use of a comparison between LSD use and marijuana use. The early history of marijuana use contains the same reports of "psychotic episodes" now current with respect to LSD. But reports of such episodes disappeared at the same time as the number of marijuana users increased greatly.

l must add a cautionary disclaimer. l have not exhaustively examined the literature on LSD. What l have to say about it is necessarily speculative with respect to its effects; what l have to say about the conditions under which it is used is also speculative, but is based in part on interviews with a few users.

The physiological effects of drugs can be ascertained by standard techniques of physiological and pharmacological research. ln contrast, the subjective changes produced by a drug can be ascertained only by asking the subject how he or she feels. People who take drugs for recreational purposes do so because they wish to experience just those subjective effects which they would either ignore or define as noxious side effects if they were taking a drug for medicinal reasons. And because the use of drugs to induce a change in consciousness seems to many immoral, drug users come to the attention of sociologists as lawbreakers.

Nevertheless, some sociologists, anthropologists, and social psychologists have investigated the problem of drug-induced subjective experience in its own right. Taking their findings together the following conclusions seem justified (Becker 1963; Blum and Associates 1964;*

*Material on this page was taken from "History, Culture and Subjective Experience: An Exploration of the Social Bases of Drug-lnduced Experiences." See footnote 1.